Postoperative pain treatment after pancreatic surgery—a descriptive study of multimodal pain treatment after removal of epidural anaesthesia

Introduction

Postoperative pain management after pancreatic surgery is challenging, particularly during the transition from epidural anaesthesia (EDA) to oral analgesics. Enhanced Recovery Program (ERP) recommend multimodal analgesia to reduce opioid-related adverse effects, however optimal regimens remain unclear.

The aim of this study was to investigate whether multimodal pain treatment was administered according to ERP guidelines after pancreatic surgery, during and after removal of the epidural anaesthesia, at Sahlgrenska University Hospital. Secondary objectives include comparing high- versus low opioid dose groups and identifying modifiable factors.

Methods

This retrospective single-centre study included patients undergoing pancreatic surgery between June 2021 and June 2023. Patients were stratified into low (≤30 mg/day) and high (>30 mg/day) opioid use groups based on oral morphine equivalent daily dose (oMEDD).

Results

A total of 194 patients were included, of whom 52% were men. Pain assessment was undocumented in 70% of patients after EDA weaning. Full-dose paracetamol was administered in 74% of the patients, while 16% received additional non-opioid analgesics. Smokers had higher odds of receiving high opioid doses (OR 3.16, P = 0.032). The high-dose group reported significantly higher pain scores (P = 0.038) and infusion rates (P ≤ 0.001) in the postoperative unit, as well as higher rescue oral opioid use on the day of EDA weaning and the following day (P ≤ 0.001).

Discussion

Multimodal pain treatment was administered to some extent after EDA-weaning, however, potential areas of improvement were identified where an opioid-sparing regimen could further benefit patients.